What can we do to avoid episiotomies and tears in childbirth: the advice of a specialized physiotherapist

One of the possible complications of childbirth that generates more fear is the perineal trauma, name that receives the tear or episiotomy produced at the time of the expulsion. Although the new protocols are trying to re-educate professionals to intervene less and let the delivery flow without haste, not everything is in the hands of doctors and the woman can also do things to avoid such situations.

We talked with Elena Valiente, a physiotherapist specialized in pelvic floor at the clinic "Duque de Sevilla - Gynecology and Physiotherapy of women", about what the pregnant woman can do to avoid episiotomies and tears.

Perineal massage ... but not only that

On several occasions we have talked about perineal massage as one of the main resources that we can put into practice to avoid, as far as possible, that tears or episiotomies occur during childbirth.

The goal of perineal massage is to stretch the perineum, soften it and give it elasticity so that at the time of delivery it is more prepared to open. In addition, the massage serves to know a little about the sensations that will happen during childbirth and get acquainted with them, thus helping to relax the area at the peak of delivery.

"Perineal massage helps improve vascularization of the vaginal area. The weight that is supported during pregnancy, reduces oxygenation of the vulva, hence its classic bluish appearance in the last stage of pregnancy. This is important to improve face to childbirth, to avoid complications "- advises the physiotherapist.

Elena is blunt about the effectiveness of perineal massage: "It has been shown that this type of massage helps reduce the risk of episiotomy and tear during childbirth by up to 30 percent, but logically massage is not everything"

And that, as the physiotherapist explains, perineal massage forms only part of the preparation to be carried out by women during pregnancy, and that includes among other aspects:

  • Take care of the weight you gain throughout pregnancy

  • Perform Kegel exercises regularly to gain perineal strength

  • Be fit and lead an active life during the nine months of pregnancy, so that we combine both relaxed breathing exercises, stretching and postures such as yoga or pilates, with cardiovascular exersise

When and how to perform perineal massage?

So, and on the basis that perineal massage is just one more help, Elena explains how and when to do it to make it more effective:

"My recomendation is start making them from week 35, and not before, because I have ever met women who have started doing them much earlier and when they have reached week 36 they have tired and left. And precisely this last stage is the important one "

"With ten minutes a day is enough if done well. Therefore, my advice is that it is not the same person who does it, but ask the couple for help. Because one will only be able to massage with the thumb, so that only the entrance area to the vagina will work. While the couple can reach much deeper pelvic floor planes "

In her clinic, Elena explains to couples who wish to start with the massages how they should perform them, and although we take this opportunity to remember a post by Armando where we explained the technique of perineal massage, it is convenient always consult with a pelvic floor specialist to guide us in its correct execution.

Is rosehip oil effective?

There is much talk about rosehip oil as an ally to promote skin elasticity. But nevertheless, for perineal massages Elena does not recommend it, and instead bet on lubricants similar to vaginal mucus, such as Cumlaude's Mucus gel.

"Perineal massage is annoying, and rosehip oil is absorbed quickly, so it tends to make more friction when massaging, and this causes greater contraction of the muscles of the perineum and, therefore, greater discomfort "

"It is better to opt for lubricating gels and once we have finished the perineal massage, resort to, if you want a gentle massage with rosehip oil or some other that can be used for this purpose"

Is the use of Epi-No effective?

A few years ago, an apparatus called Epi-No was introduced, which is presented as a pelvic floor exerciser to prepare the perineum Looking forward to delivery. What this device does is to familiarize the woman with the sensation and pressure she will feel in the perineum at the time of the expulsion, helping her to control her bids.

However, from the Association El Parto es Nuestro they do not recommend it, nor does Elena.

"I always work based on scientific evidence, and I adapt to new studies. For the moment, there is no evidence that Epi-No reduces the risk of episiotomies and tears in childbirth "

"On the other hand, It would be logical to use the Epi-No if the woman is clear that she will not want epidural in childbirth, but if this is not the case, this device is of no use since the sensation of pressure in the perineum that is felt when using the Epi-No, and that therefore serves to know how to direct the bids, disappears at the moment in that the epidural is administered "

At the time of delivery, what can be done to avoid tears and episiotomies?

The physiotherapist insists that the fact of carrying out a correct preparation during pregnancy, combined with perineal massages, helps to reduce the risk of episiotomies and tears in childbirth, but unfortunately they do not avoid it.

And is that there are many other factors that can interfere at the time the delivery ends with tears or need for episiotomy:

  • Macrosomic babies, or weighing more than 4 kilos

  • Baby with a large cranial perimeter

  • Expulsive very fast, that is, babies born in a single bid, since the perineum does not have time to gradually expand

  • Instrumental delivery

  • A very long delivery

  • Amount of epidural anesthesia administered

"If the woman gains a lot of kilos, the final stretch will face her in a heavy and little active way, and as a result she will arrive tired and in low form at the birth. In addition, if she decides to become epidural, a greater amount of anesthesia will be needed (since this is a function of weight), and the higher the dose of anesthesia, the more likely it is that the delivery will not be controlled, that the labor is lengthened and instrumental help is required "

In addition, Elena highlights the importance of the fact that if everything goes well, the professionals let the delivery flow without haste, and that the woman can dilate calmly and with freedom of movement, making use if she wants of balls and bathtubs of dilatation.

In summary, if you are pregnant and you are worried about the time of delivery, remember that you can do several things to prevent it from ending with perineal trauma. Ask all your questions to your midwife or a physiotherapist specializing in gynecology and pelvic floor!

Acknowledgments Elena Valiente

IStock photos

In Babies and More Performs a perineal massage to improve labor conditions, Episiotomy raises the risk of tearing in the next delivery, Percentages of episiotomies in European countries, Curious viral video: a balloon and a ping pong ball to explain what it happens in childbirth

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Video: Episiotomy (March 2024).